title: Pre-emptive broad-spectrum treatment for ventilator-associated pneumonia in high-risk patients.
abstract: OBJECTIVE
  Patients requiring mechanical ventilation (MV) for >48 h after major heart surgery (MHS) are at a high risk of acquiring ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Most non-pharmacological interventions to prevent VAP in such patients are usually already implemented. The objective of this study was to evaluate the efficacy in preventing lower respiratory infections of antibiotics active against multidrug-resistant pathogens in this very high-risk population.
  
  
  METHODS
  We performed a prospective randomized open-label study of MHS patients requiring MV for >48 h. Patients were randomly allocated to one of two groups: the intervention group, which received a 3-day course of linezolid and meropenem, and the control group, which received the standard of care. The main outcome was the development of VAP or VAT.
  
  
  RESULTS
  Overall, of the 78 patients included in the study, 40 were in the intervention group and 38 in the control group. Both groups were comparable. Data for the intervention and control groups respectively were as follows: VAP + VAT/1,000 days was 31.79 vs 64.78 (p = 0.03), median length of MV before the first episode of VAP or VAT 9 vs 4.5 days (p = 0.02). No significant differences were observed in median length of stay in the intensive care unit, median length of hospital stay, antibiotic use, Clostridium difficile infection, and overall mortality rate. We detected linezolid-resistant coagulase-negative and coagulase-positive staphylococci in the MHS intensive care unit after the study period.
  
  
  CONCLUSIONS
  A pre-emptive approach with broad-spectrum antibiotics may be effective in reducing the incidence and delaying the onset of VAP + VAT after MHS. The ecological consequences have to be carefully evaluated in future trials.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. ebouza@microb.net
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
authors.forename: María Jesús Pérez
authors.initials: MJ
authors.lastname: Granda
authors.forename: Javier
authors.initials: J
authors.lastname: Hortal
authors.forename: José M
authors.initials: JM
authors.lastname: Barrio
authors.forename: Emilia
authors.initials: E
authors.lastname: Cercenado
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D000069349:Linezolid; D008297:Male; D000077731:Meropenem; D023303:Oxazolidinones / Q000627:therapeutic use*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D013845:Thienamycins / Q000627:therapeutic use*
chemical_list: D000081:Acetamides; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D013845:Thienamycins; D000077731:Meropenem; D000069349:Linezolid